Gastroesophageal reflux disease: surgical considerations

Technical advances are changing the attitude toward surgery as a last-resort treatment option for gastroesophageal reflux disease (GERD). Although a number of effective medications are currently available to manage GERD, surgery is definitive therapy, and its results are long-term, eliminating both medication compliance problems and the high cost of lifelong drug therapy. Numerous procedures are available for GERD; laparoscopic Nissen fundoplication is emerging as highly suitable and successful for most patients with simple GERD. For the best clinical result, however, the procedure must be tailored to the patient's disease and to the preoperative study results of esophageal pathology and function. The multidisciplinary collaboration of the gastroenterologist, radiologist, and surgeon will be key to the future management of GERD.